Question 1

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to:

Accepted Answer

The nurse's first action should be to massage the woman's fundus to ensure that it is firm and to promote uterine contraction, which will help control the bleeding. If the bleeding persists, the nurse should then assess the woman's vital signs and call the primary health care provider. An IV infusion may be initiated if the bleeding cannot be controlled by massage, vital signs are unstable or if the woman's blood loss is severe.

Question 2

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:

Accepted Answer

Not giving the baby a name at 6 weeks postpartum may indicate the mother is not emotionally connected to the baby or experiencing difficulty bonding. This can be a concerning psychosocial outcome and may require further assessment and support. A, B, and D are not necessarily indicators of poor psychosocial outcomes in the postpartum period. It is common for women to want to discuss their labor and birth experience, feel positively about their baby's appearance and abilities, and receive positive support from their partner or family.

Question 3

With regard to rubella and Rh issues, nurses should be aware that:

Accepted Answer

Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination to prevent potential harm to a developing fetus.

Question 4

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is:

Accepted Answer

If all other methods of bladder emptying have failed, the nurse may need to intervene with a sterile catheterization to prevent the bladder from interfering with the progress of labor.

Question 5

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:

Accepted Answer

Applying ice to the breasts can help reduce swelling and provide comfort for engorgement, which is common when milk comes in after childbirth, especially if the mother is not breastfeeding.

Question 6

If a mother and her family have freely chosen early discharge from the hospital, the nurse and the health care provider are not legally responsible if complications occur and her condition had not been stabilized within normal limits.

Accepted Answer

If complications should occur after discharge, the nursing and medical staff could be sued for abandonment.

Question 7

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth.

Accepted Answer

The Newborns' and Mothers' Health Protection Act requires health plans to allow new mothers and newborns to remain in the hospital for a minimum of 48 hours after a normal vaginal birth and for 96 hours after a cesarean birth. Therefore, the correct choice is C.

Question 8

Excessive blood loss after childbirth can have several causes; the most common is:

Accepted Answer

Failure of the uterine muscle to contract firmly, known as uterine atony, is the most common cause of excessive bleeding after childbirth. This can occur due to a variety of factors, including over-distension of the uterus, anesthesia, or medications used during labor. Treatment typically involves massage of the uterus, medication to stimulate contractions, or, in severe cases, surgery.

Question 9

If a woman is at risk for thrombus and is not ready to ambulate, nurses might intervene by doing all of these interventions except:

Accepted Answer

Sitting in a chair for prolonged periods of time can increase the risk of thrombus formation. The other interventions, including antiembolic stockings, sequential compression devices, and foot/ankle exercises, help to prevent thrombus formation. Notifying the physician immediately if a positive Homans' sign occurs is also important as it can indicate a potential thrombus.

Question 10

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

Accepted Answer

The orders for perineal ice packs, use of a sitz bath tid, and a stool softener are commonly prescribed for women who have had an episiotomy or experienced perineal trauma during birth. The other options given do not directly correlate with these orders.

Question 11

In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:

Accepted Answer

If the numb or prickly sensations are gone from her legs after these movements,she likely has recovered from the epidural or spinal anesthesia.It is always important to assess the client for bleeding beneath her buttocks prior to discharge from the recovery room;however,she should be rolled to her side for this assessment.The nurse is not required to assess the woman for flexibility.This assessment is performed in order to evaluate if the client has recovered from spinal anesthesia,not to determine if she is a candidate for early discharge.

Question 12

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse's most appropriate response is:

Accepted Answer

The most appropriate response is to accommodate the husband's request and warm the soup in the microwave for the patient. It is not the nurse's place to question the patient's choice of food, as long as it is not contraindicated for her condition.

Question 13

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to:

Accepted Answer

"Taking the time to mother the mother" refers to nurturing the woman by providing emotional support and encouragement as she navigates the challenges of new motherhood. This may include discussing breastfeeding techniques, offering tips for soothing a crying baby, and addressing any concerns or questions the mother may have. It is an important aspect of nursing care in the fourth trimester, as it can help promote maternal bonding, reduce stress and anxiety, and support the woman's overall wellness during this vulnerable time. Choices A, B, and C may also be important aspects of nursing care, but they do not specifically relate to the concept of "mothering the mother."

Question 14

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:

Accepted Answer

In couplet care, the mother and infant share a room, and the mother shares the care of the infant with the nurse, who provides support and education to the mother.

Question 15

Regardless of her obstetric status, no woman should be discharged from the recovery area until she has completely recovered from the effects of anesthesia and has been cleared by a member of the anesthesia care team.

Accepted Answer

It takes several hours to recover from anesthesia. Obstetric recovery areas are held to the same standard of care expected for any postanesthesia recovery.

Question 16

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

Accepted Answer

The nurse soaking and recording information about the perineal pads suggests that she is trying to improve the accuracy of blood loss estimation. This is typically a subjective assessment and can vary depending on the nurse's experience and perception. By using a more objective method, such as measuring the amount of blood on the pads, the nurse can provide more accurate information to the healthcare team.

Question 17

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Accepted Answer

The most common cause of postpartum hemorrhage is uterine atony, which occurs when the uterus is unable to contract effectively after delivery. This can be caused by a variety of factors, including prolonged or rapid labor, fetal macrosomia, multiple gestation, use of Pitocin for augmentation, and retained placental fragments. However, in this case, the patient underwent augmentation of labor with Pitocin and delivered a large baby, making uterine atony the most likely cause of her bleeding. Retained placental fragments may also contribute, but uterine atony is the primary concern. Unrepaired vaginal lacerations and puerperal infection are less likely causes of postpartum hemorrhage in this scenario.

Question 18

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

Accepted Answer

The rubella titer indicates that the woman is not immune to rubella and should receive the vaccine after delivery. The blood type and Rh status indicate no need for transfusion or Rh immune globulin. The low hematocrit may indicate anemia, but it is not a concerning result requiring immediate intervention. A Kleihauer-Betke test would only be necessary if there was a risk of fetal-maternal bleeding leading to a potential need for Rh immune globulin.

Question 19

Which finding could prevent early discharge of a newborn who is now 12 hours old?

Accepted Answer

The infant having difficulty latching on and sucking and only partially breastfeeding could indicate potential feeding difficulties, which could impact their ability to eat and gain weight, ultimately affecting their ability to be discharged. The other options indicate normal functioning and would not impact the decision for discharge at this time.

Quiz 14: Nursing Care of the Family During the Fourth Trimester